#949 of 11K

J0129

Injection, abatacept, ten milligrams intravenous

Injection, abatacept, ten milligrams intravenous is the #949 most-billed Medicaid procedure code, with $55.5M in payments across 34K claims from 2018–2024. The national median cost per claim is $1,286.08. Costs vary widely — the 90th percentile is $2,885.57 per claim, 2.2× the median.

Total Paid

$55.5M

0.01% of all spending

Total Claims

34K

Providers

Avg Cost/Claim

$2K

National Cost Distribution

How much do providers bill per claim for J0129? Based on 75 providers billing this code nationally.

Median

$1,286.08

Average

$1,467.39

Std Dev

$947.43

Max

$3,487.81

Percentile Distribution (Cost per Claim)

p10

$458.33

p25

$708.54

Median

$1,286.08

p75

$2,115.87

p90

$2,885.57

p95

$3,250.35

p99

$3,464.06

50% of providers bill between $708.54 and $2,115.87 per claim for this code.

90% bill between $458.33 and $2,885.57.

Top 1% bill above $3,464.06.

About This Procedure

HCPCS code J0129 (Injection, abatacept, ten milligrams intravenous) was billed by 78 providers across 34K claims, totaling $55.5M in Medicaid payments from 2018–2024. This code was used for 29K unique beneficiaries.

Fraud Risk Context

Injectable drug codes carry high per-claim costs and have been involved in drug diversion and upcoding schemes.

Source: HHS OIG Reports

Risk Assessment

Billing Statistics

Median Cost/Claim

$1,286.08

Providers Billing

National Spending

$55.5M

Avg/Median Ratio

1.14×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J0129

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1477914232	$9.0M	$3,204.66	2.5× median	Top 10%
2	1174822902	$7.4M	$2,733.74	2.1× median	Above 75th
3	1275984700	$5.5M	$3,455.72	2.7× median	Top 10%
4	1841352663	$3.1M	$1,861.36	1.4× median	Above Median
5	1497979629	$2.2M	$3,093.07	2.4× median	Top 10%
6	1528248242	$2.1M	$1,345.20	1.0× median	Above Median
7	1548717580	$1.9M	$2,054.36	1.6× median	Above Median
8	1447308168	$1.8M	$2,425.59	1.9× median	Above 75th
9	Yuma Regional Medical Center Yuma, AZ · General Acute Care Hospital	$1.4M	$1,275.91	1.0× median	Below Median
10	Unm Hospital Albuquerque, NM · General Acute Care Hospital	$1.4M	$1,538.17	1.2× median	Above Median
11	1972606549	$1.4M	$3,356.95	2.6× median	Top 10%
12	Arthritis & Rheumatology Associates Of South Jersey Pc Vineland, NJ · Internal Medicine Rheumatology	$1.3M	$2,523.83	2.0× median	Above 75th
13	1770842098	$1.3M	$686.49	0.5× median	Below Median
14	1932145414	$1.3M	$2,211.06	1.7× median	Above 75th
15	1821602194	$1.3M	$1,855.84	1.4× median	Above Median
16	1659865962	$1.1M	$2,986.79	2.3× median	Top 10%
17	1609812544	$1.1M	$1,389.33	1.1× median	Above Median
18	1477047256	$960K	$1,496.00	1.2× median	Above Median
19	1659342061	$884K	$2,394.58	1.9× median	Above 75th
20	1245340231	$722K	$524.73	0.4× median	Below Median

Showing top 20 of 78 providers billing this code

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